Self‐Reported Help‐Seeking Behaviors and Treatment Choices of Adolescents Regarding Acne

Abstract: Acne vulgaris is a common condition affecting adolescents that they often choose to treat on their own rather than seek out and follow medical advice. Using data from an anonymous survey administered to 1,214 students in public middle and high schools in New Jersey, we compared the self‐reported acne frequency, severity, and beliefs of students based on their help‐seeking behaviors, treatment choices, and treatment adherence. Chi‐square analyses were performed for data comparison. A large proportion of students in this sample (57%) treated their own acne, and a much smaller proportion (17%) have sought medical care. Students who saw a health professional reported acne of higher frequency and severity than those who did not (p = 0.01). Severity also appeared to affect treatment adherence, with students who adhered to recommended treatments reporting more frequent (p < 0.001) and more severe (p = 0.02) acne than those who chose to self‐treat. Beliefs and knowledge varied most significantly according to treatment adherence. In conclusion, most adolescent students treat their own acne. Self‐assessment of acne severity plays a significant role in the tendency to seek out and adhere to medical treatment. Beliefs and knowledge may also affect adherence, suggesting a role for physicians to influence adherence rates through patient education. Because the majority of students are getting information from nonphysician sources, there may be a need to evaluate the resources they are using to make sure they are receiving appropriate, helpful information.     

A cross‐sectional,multi‐center study on treatment of facial acne scars with low‐energy double‐pass 1450‐nm diode laser

Acne scars are the ultimate outcome of acne vulgaris, a prevalent skin disorder affecting the pilo‐sebaceous unit. Laser resurfacing has been demonstrated to be an efficient therapy option for acne scars. Hence, we adopted this concept and conducted a study to evaluate the safety and efficacy of low‐energy double‐pass 1450‐nm diode laser on acne scars. This study was conducted on 48 patients with acne scars, treated at 4‐week interval with low‐energy double‐pass 1450‐nm diode laser. Patients were evaluated clinically and with photographs, at day 0, first month and third month post the final treatment and during follow‐up visit. Five treatment sessions were completed by all patients. Approximately, 79.2% of patients showed around 30% improvement. At the end of third month follow‐up, 92.9% of the patients demonstrated >30% improvement. Vesicle formation was observed in two cases, with no post‐inflammatory hyperpigmentation and transient hyperpigmentation was observed in one case, which vanished within 2 months. Our study showed that 1450‐nm diode laser treatment was efficient and well endured in facial acne scars when used with double‐pass at low‐energy.     

Combined autologous platelet‐rich plasma with microneedling versus microneedling with non‐cross‐linked hyaluronic acid in the treatment of atrophic acne scars: Split‐face study

Acne scarring causes cosmetic discomfort, depression, low self‐esteem and reduced quality of life. Microneedling is an established treatment for scars. A multimodality approach to scar treatment is usually necessary to achieve the best cosmetic results. The objective of this study was to evaluate the efficacy and safety of platelet rich plasma (PRP) combined with microneedling in comparison with microneedling with non‐cross‐linked hyaluronic acid for the treatment of atrophic acne scars. Forty‐one patients of 20‐40 years of age with atrophic acne scars were included. Microneedling was performed on both halves of the face. Topical application of PRP was given on right half of the face, while the left half of the face was treated with topical application of non‐cross‐linked hyaluronic acid. Four treatment sessions were given at an interval of 1 month consecutively. Goodman's Qualitative scale and the quartile grading scale are used for the final evaluation of results. There was a statistically significant improvement in acne scars after treatment among the studied group. Right and left halves showed 85.4% and 82.9% improvement, So the difference of the improvement between the two modalities is statistically insignificant P > 0.05 We conclude that microneedling has efficacy in the management of atrophic acne scars. It can be combined with either PRP or noncross‐linked hyaluronic acid to enhance the final clinical outcomes in comparison with microneedling alone. The difference between the two modalities is insignificant.     

Clinical studies of the treatment of facial atrophic acne scars and acne with a bipolar fractional radiofrequency system

Few clinical studies have examined the utility of bipolar fractional radiofrequency (FRF) therapy as a treatment for atrophic acne scars and active acne in people with darker skin. This study was designed to compare the safety and efficacy of bipolar FRF therapy as a treatment for atrophic acne scars and acne vulgaris. Twenty‐three Japanese patients with atrophic acne scars and mild to severe acne on both cheeks were treated with a bipolar FRF system (eMatrix; Syneron, Yokneam Illit, Israel). Five treatment sessions were carried out at 1‐month intervals, and the patients were followed up for 3 months after the final treatment. Assessments of scar severity and the number of acne lesions and 3‐D in vivo imaging analysis were performed. Evaluations of the treatment outcomes and their effects on the patients’ quality of life (QOL) were also carried out. We demonstrated that the improvement in scar volume was marked in the patients with mild scars and was at least moderate in 23 (57.5%) of the treated areas. With regard to the number of acne lesions, the treated areas exhibited significantly fewer lesions compared with the baseline at each time point (P < 0.05). The patients’ assessments of the treatment outcomes and their QOL indicated that both had improved significantly by the end of the study. Furthermore, significant reductions in the patients’ sebum levels, skin roughness and scar depth were observed. Bipolar FRF treatment significantly improved the atrophic acne scars and acne of Japanese patients and had minimal side‐effects.     

Community‐based epidemiological study of psychosocial effects of acne in Japanese adolescents

In this community‐based cross‐sectional study, 1443 Japanese adolescents aged 13–19 years participated from two schools in Kagawa Prefecture. Students completed a self‐administered questionnaire to assess the prevalence of acne, knowledge about acne, self‐management of acne and emotional well‐being. A five‐item version of the Mental Health Inventory (MHI) subscale of the Short Form 36 was used to assess psychological health and depression status. Among respondents, 859 (59.5%) said they had acne (51.6% of the boys and 64.8% of the girls). A majority (56.8%) of those who said they had acne also reported a family history of acne. Of the 555 female respondents with acne, 39.1% reported experiencing acne flares in temporal proximity to menstruation. Less than half (38.8%) of respondents with acne had sought or were seeking treatment. The three most common factors believed to trigger or exacerbate acne were stress, lack of sleep and sweat. The mean MHI score of 847 students with acne was significantly lower than 475 students without acne. The mean MHI score of female students with acne was significantly lower than male students with acne. Students with acne were also significantly more depressed than those without acne and female students were significantly more depressed than male students. Acne is a common problem for Japanese teenagers and causes personal and social difficulties. Our results suggest the necessity of educational programs in school or public to ensure that adolescents are aware of acne and to encourage young people to improve their mental health through better acne treatment.     

Most common patterns of acne in male adolescents: a population‐based study

Background Acne vulgaris is a common skin disease affecting more than 85% of adolescents and often continuing into adulthood. Population‐based studies to assess the patterns and severity of acne have not been achieved. Objectives The aim of this study was to assess the most common patterns of facial and trunk acne in young (18‐year‐old) men in a representative sample of male adolescents in a city in southern Brazil and to investigate the severity of inflammatory and non‐inflammatory lesions in these individuals. Methods In Brazil, military service is compulsory for all males. Every adolescent male must report to his military service headquarters to submit to a medical screening examination. The study included 2201 adolescents, each of whom underwent a skin examination conducted by a dermatologist to identify and quantify all non‐inflammatory (comedones) and inflammatory (papules, pustules, and nodules) lesions. Results Non‐inflammatory lesions (comedones) were observed on 1487 individuals, and inflammatory lesions (papules and pustules) were noted on 1497 individuals. The most common patterns of facial acne were the full‐face, bilateral malar and frontal mentonian distributions. Conclusions This is the first population‐based study to evaluate patterns of acne. Facial involvement was very prevalent, and the frontal region was found to dominate patterns of distribution of acne vulgaris. Comedonian acne of the face was much more intense and affected the entire face. In inflammatory facial acne, the majority of the study subjects exhibited up to five lesions in the region under study.     

Validation of self-reporting of hand eczema among Danish hairdressing apprentices

Background. Hairdressing apprentices have a high incidence of hand eczema. Most studies use self‐reported hand eczema as a cost‐effective method to estimate the prevalence of hand eczema. No validation studies on self‐reported hand eczema among hairdressing apprentices exist. Objectives. To evaluate the validity of self‐reporting of hand eczema among Danish hairdressing apprentices. Methods. During their first 2 weeks of training, 502 hairdressing apprentices were enrolled in this study. All apprentices completed a self‐administered questionnaire including questions regarding, for example, current hand eczema, and they were all clinically examined for hand eczema three times during the first part of their education by use of the Hand Eczema Severity Index. The validity of self‐reporting of hand eczema was measured with the clinical examination as the gold standard. Results. The sensitivity of self‐reporting of hand eczema was 70.3%, and the specificity was 99.8%. The positive predictive value was 96.3%, and the negative predictive value was 98.5%. Conclusions. We found good agreement between self‐reporting of hand eczema and clinical examination. There was good sensitivity and high specificity. Self‐reporting of hand eczema among hairdressing apprentices is considered to be a valid method for estimating the prevalence of hand eczema, although it might underestimate the true prevalence.     

Therapeutic considerations and clinical characteristics of a sample of adolescent patients with acne vulgaris in Tirana,Albania: A cross‐sectional study

Acne vulgaris is a common adolescent disorder but the data related to acne vulgaris is insufficient in Albania. The aim of this study was to assess the epidemiologic features of acne vulgaris and to identify lifestyle and constitutional factors in formulating a proper management protocol. A cross‐sectional study conducted on a representative sample of 2036 adolescents from 10 high schools located in Tirana. A self‐administered questionnaire was administered to collect the data. The binary logistic regression was applied to assess the factors linked to the presence of acne vulgaris in adolescents. The mean age in the study population was 16.2 ± 0.9 years. The self‐reported prevalence of acne was 50.3% (52.1% in females and 47.9% in males). Lifetime prevalence was 68.5%. The factors significantly associated with an increased likelihood over time were: frequent consumption of sweets, frequent endurance of stress, poor quality of sleep, positive family history of acne, oily and combination skin, menstrual disorders. Acne vulgaris is common among adolescents in our country. The identification of various modifiable factors related to acne generates opportunities to tailor and focus prevention efforts and better management and treatment planning in relevant high‐risk groups.     

Serial sections of atrophic acne scars help in the interpretation of microscopic findings and the selection of good therapeutic modalities

Background Acne scar causes problems cosmetically and psychologically. Although microscopic examination of acne scars is a necessity for understanding and treatment of them, and it is not easy to find a paper reporting the microscopic characterization of acne scars. Objective The aim of this study was to examine the microscopic findings of acne scars and to select a good therapeutic modality based on the findings. Methods Thirty‐one atrophic scars obtained from five patients for cosmesis and 18 serial sections were made from each atrophic scar. The sections were stained with H&E, Masson‐trichrome or Verhoeff van Gieson stains. Immunohistochemistry was done with antibodies against transforming growth factor‐β, metalloproteinase‐1 (MMP‐1), MMP‐2, MMP‐9 and MMP‐13. The stained sections were examined under the microscope. Results The epidermis of the acne scar was characterized by keratin plugging in the hair follicle orifice (32%) and multi‐channelled tracts (29%). The dermis of the acne scar had characteristics including a decrease in the dermal thickness and loss of pilosebaceous units. In addition, inflammatory cell infiltrates were seen in the dermis (77%), and insufficient dense collagen fibre deposition was found in the whole dermis (29%). Other findings such as calcium deposition and foreign body reaction were discovered. Conclusion We have found the characteristics of acne scar through the serial sections of several atrophic scars, and suggest that the treatment must reflect several considerations, including the understanding of histopathological findings and the use of combination therapy.     

Prevalence of scars and “mini‐scars”, and their impact on quality of life in Japanese patients with acne

There have been very few studies on the prevalence and severity of acne scars in Japanese patients. The aim of the present study was to investigate the prevalence of acne scars and their impact on the quality of life (QOL) in Japanese acne patients. Acne scars were classified as mini‐scars (atrophic scars of ≥0.5 and <2 mm in diameter) atrophic scars (≥2 mm in diameter), and hypertrophic scars. The severity of acne and acne scars were evaluated. The background of patients and their QOL in relation to acne were assessed. Of 240 subjects, 218 (90.8%) had scars. All patients with scars had mini‐scars; 61.2% and 14.2% of 240 had atrophic scars and hypertrophic scars, respectively. Severe scarring was found in patients who had experienced severe acne symptoms, although 15.0% of patients with scars had experienced only mild acne symptoms. The total Dermatology Life Quality Index score was significantly higher in patients with scars than in patients without scars (5.9 ± 4.4 vs 4.2 ± 4.1). Almost all the patients had small atrophic scars with a diameter of 0.5 or more and less than 2 mm, which we have termed “mini‐scars”. Acne scars had a negative impact on patient QOL. Early initiation of treatment is recommended to avoid acne scars.     

Comparison of dermatoscopic diagnostic algorithms based on calculation: The ABCD rule of dermatoscopy,the seven‐point checklist,the three‐point checklist and the CASH algorithm in dermatoscopic evaluation of melanocytic lesions

Dermatoscopic analysis of melanocytic lesions using the CASH algorithm has rarely been described in the literature. The purpose of this study was to compare the sensitivity, specificity, and diagnostic accuracy rates of the ABCD rule of dermatoscopy, the seven‐point checklist, the three‐point checklist, and the CASH algorithm in the diagnosis and dermatoscopic evaluation of melanocytic lesions on the hairy skin. One hundred and fifteen melanocytic lesions of 115 patients were examined retrospectively using dermatoscopic images and compared with the histopathologic diagnosis. Four dermatoscopic algorithms were carried out for all lesions. The ABCD rule of dermatoscopy showed sensitivity of 91.6%, specificity of 60.4%, and diagnostic accuracy of 66.9%. The seven‐point checklist showed sensitivity, specificity, and diagnostic accuracy of 87.5, 65.9, and 70.4%, respectively; the three‐point checklist 79.1, 62.6, 66%; and the CASH algorithm 91.6, 64.8, and 70.4%, respectively. To our knowledge, this is the first study that compares the sensitivity, specificity and diagnostic accuracy of the ABCD rule of dermatoscopy, the three‐point checklist, the seven‐point checklist, and the CASH algorithm for the diagnosis of melanocytic lesions on the hairy skin. In our study, the ABCD rule of dermatoscopy and the CASH algorithm showed the highest sensitivity for the diagnosis of melanoma.     

Intense pulsed light vs. pulsed‐dye laser in the treatment of facial acne: a randomized split‐face trial

Background Various laser and light therapy have been increasingly used for the treatment of acne vulgaris. Patients and methods Twenty patients with facial acne were treated using intense pulsed light (IPL) on one side of the face and pulsed dye laser (PDL) on the other to compare the efficacy and safety of IPL and PDL. Treatment was performed 4 times at 2‐week intervals. Treatment effectiveness was determined using lesion counts, acne severity, patient subjective self‐assessments of improvement, and histopathological examinations, which included immunohistochemical staining for transforming growth factor‐β (TGF‐β). Results Numbers of total acne lesions decreased following both treatments. For inflammatory lesions such as papules, pustules and nodules, IPL‐treated sides showed an earlier and more profound improvement than PDL‐treated sides. However, at 8 weeks after the 4th treatment, a rebound aggravation of acne was observed on IPL‐treated sides. On the contrary, PDL produced gradual improvements during the treatment sessions and these improvements lasted 8 weeks after the 4th treatment. Non‐inflammatory lesions as open and closed comedones also showed improvement following both treatments and PDL‐treated sides showed better improvement as the study proceeded. Histopathological examinations showed amelioration in inflammatory reactions and an increase in TGF‐β expression after both treatments, which were more prominent for PDL‐treated sides. Conclusion Both PDL and IPL were found to treat acne effectively, but PDL showed a more sustained effect. TGF‐β might play a key role in the resolution of inflammatory acne lesions.     

Frequency and characteristics of acne‐related post‐inflammatory hyperpigmentation

In patients with darker skin types (Fitzpatrick phototypes III–VI), acne is often accompanied by post‐inflammatory hyperpigmentation (PIH). Further, acne‐related pigmentation can pose a greater concern for the patient than the acne lesions. There has been little formal study of this acne‐related PIH. Recently, the Asian Acne Board – an international group of dermatologists with interest in acne research – made a preliminary evaluation of the frequency and characteristics of PIH in seven Asian countries. A total of 324 sequential acne subjects were evaluated for the presence of PIH. The majority (80.2%) of subjects had mild to moderate acne and there were more females than males (63.0% vs 37.0%). In this population of patients consulting a dermatologist for acne, 58.2% (188/324) had PIH. The results also showed that pigmentation problems are often long lasting: at least 1 year for more than half of subjects and 5 years or longer in 22.3%. In accordance with our clinical experience, patients reported that PIH is quite bothersome, often as bothersome or more so than the acne itself and sometimes more problematic. Excoriation was commonly reported by patients, and may represent a modifiable risk factor that could potentially be improved by patient education.     

The pinhole method using an erbium: YAG laser for the treatment of papular acne scars

Papular acne scars are skin‐colored or hypopigmented, soft and elevated lesions of the chin and trunk. Papular scars are one of the most difficult acne scars to treat. Herein, we reported two patients with papular acne scars on the chin that were successfully treated by the pinhole method using an Erbium (ER):YAG laser. Good cosmetic results were achieved in both patients. The side effects included mild, intra‐, and post‐procedural pain and erythema that resolved spontaneously within 2 weeks. The pinhole method with an Er:YAG laser could potentially be used as a safe and effective treatment for papular acne scars.     

Acne: prevalence, perceptions and effects on psychological health among adolescents in Aydin, Turkey

Background Acne vulgaris is a common disease among adolescents and known to have adverse effects on psychological status. Methods A cross‐sectional study was conducted on 600 participants by means of a questionnaire designed for this study in high school students. In addition, an objective evaluation of acne in participants was undertaken. The questionnaire consisted of questions about acne, General Health Questionnaire (GHQ) and Rosenberg Self‐Esteem Scale (RSES). Results Five hundred and sixty‐three questionnaires out of 600 were answered and 550 adolescents who gave permission for examination were evaluated. The study population consisted of 303 girls and 260 boys between the ages 13 and 19, and the mean age was 15.24 ± 1.05 years. Acne prevalence was 63.6% with 29.2% non‐inflammatory and 34.4% inflammatory acne. It was more prevalent and severe in boys than in girls. Not the objective but the subjective severity of acne and opinion that one could benefit from acne treatment was found to be related to anxiety, depression and self‐esteem. Factors implicated among causes of acne were food, bad skin hygiene and hormones in decreasing frequency. Forty‐eight per cent of adolescents expect a maximum duration of 4 weeks for treatment. Conclusion Despite the high prevalence of acne, there is still much deficiency of knowledge and wrong beliefs about acne. This indicates that there is an urgent need for education about etiopathogenesis, potential complications and importance of effective treatment for acne. Effective treatment may make significant contributions for the mental health of adolescent and as well as adult populations.     

Efficacy of skin self‐examination for the early detection of melanoma

The National Cancer Institute's “Melanoma Action Plan” calls for reduction of melanoma mortality through early detection. Routine skin self‐examination (SSE) has the potential to increase chances of early detection and treatment and may be the key to melanoma survival. We provide a focused review of the accuracy of SSE for detecting premalignant lesions and cutaneous risk factors for melanoma, with suggestions for future directions for enhancing measurement of SSE accuracy and ways in which to improve the public's perceptions of melanoma efficacy. We examined published data on the efficacy of skin self‐examination for the early detection of melanoma. We searched the MEDLINE database for publications between January 1, 1987 and June 1, 2007 using search terms for “melanoma” and “self‐examination.” We found that sensitivity of skin self‐examination is low, ranging from 25% to 93%, while specificity is generally higher (83% to 97%). Attempts to increase improve the lay public's perceptions of the early signs of melanoma have proved effective, while those aimed at increasing accuracy of SSE with targeted interventions have been moderately successful. SSE's insensitivity for detection of pigmented lesions should prompt further investigation of educational interventions to enhance its accuracy and lead to its adoption as a cheap, simple screening tool. Assessment of the accuracy and efficacy of SSE should proceed using standardized definitions and measurements such that it is easier to pool data on the overall value of SSE as a screening modality.     

Treatment‐seeking behavior,knowledge and beliefs about acne vulgaris among adolescents: A cross‐sectional study in high school students in Tirana,Albania

Acne vulgaris is a common adolescents' disorder. Nevertheless, there is lack of knowledge about acne among adolescents. To evaluate the adolescents' knowledge and beliefs about acne, to investigate help‐seeking behavior and treatment preferences. A cross‐sectional study conducted in 10 public high schools in Tirana. A total of 2036 students enrolled. All participants were asked about socio‐demographic data, knowledge and beliefs about acne, treatment‐seeking behaviors and clinical preferences. Of participants 45.3% thought acne is a medical problem, 23.1% thought it's a cosmetic problem, and less than 10% thought acne is a normal condition for their age. Of adolescents 30% did not know that acne is not contagious, 49.7% believed acne is curable with prescribed medication, 33.4% thought acne heals by itself, and only 0.9% believed acne is non‐curable. Male adolescents were more likely to have lower level of knowledge and misconceptions about acne compared to females. Only 18.5% had consulted a dermatologist. The majority (54.7%) were using anti‐acne products recommended by their friends or pharmacists. Only minority of Albanian adolescents with acne consults a dermatologist. Age, gender and acne severity play a significant role in determining help‐seeking behavior. Patient and parent education can significantly improve the treatment outcome.     

The clinical and histological effect of home‐use,combination blue–red LED phototherapy for mild‐to‐moderate acne vulgaris in Korean patients: a double‐blind,randomized controlled trial

Background Blue and red light have been reported to have beneficial effects on acne. However, there has been no double‐blind, randomized study of acne treatment for combined blue and red light‐emitting diode (LED) devices, and the associated molecular mechanisms have rarely been investigated. Objectives To evaluate the efficacy, safety and histological changes of combined blue and red LED phototherapy for acne vulgaris. Methods Thirty‐five patients with mild‐to‐moderate acne were randomly assigned to either a home‐use irradiation group using an LED device, or a control group using a sham device. The treatment group was instructed to serially irradiate their forehead and cheeks with 420‐nm blue light and 660‐nm red light for 2·5 min twice daily for 4 weeks. Results At the final visit at 12 weeks, both inflammatory and noninflammatory acne lesions had decreased significantly, by 77% and 54%, respectively, in the treatment group. No significant difference was observed in the control group. In the treatment group, sebum output reduction, attenuated inflammatory cell infiltrations and a decreased size of the sebaceous gland were found. The immunostaining intensities for interleukin (IL)‐8, IL‐1α, matrix metalloproteinase‐9, toll‐like receptor‐2, nuclear factor‐κB, insulin‐like growth factor‐1 receptor and sterol response element binding protein (SREBP)‐1 were reduced concomitantly. Messenger RNA expression of SREBP‐1c was also decreased. No severe adverse reactions were reported. Conclusions This LED phototherapy was safe and effective for treating not only inflammatory but also noninflammatory acne lesions, with good compliance. The experimental results correlated well with clinical results, partly elucidating the related molecular mechanisms.     

Self‐Reported Acne Severity,Treatment, and Belief Patterns across Multiple Racial and Ethnic Groups in Adolescent Students

Abstract: Acne vulgaris is a common condition among adolescents regardless of age, gender, and race. We compare the frequency, severity, help‐seeking behavior, treatment, and beliefs about acne among students based on race, ethnicity, gender, and age. Anonymous surveys were administered to 1,214 students aged 10–19 years of varied gender, race, and ethnicity in public middle and high schools in New Jersey. Results showed the frequency and severity of acne were high (76% and 65%, respectively) and more prevalent in white compared to non‐white respondents (RR = 1.13, 95% CI = 1.04–1.24 and RR = 1.22, 95% CI = 1.09–1.37, respectively), and also in older compared to younger ages (RR = 1.24, 95% CI = 1.17–1.32 and RR = 1.43, 95% CI = 1.32–1.55, respectively). The majority of respondents (83%) reported never having seen a physician for their acne; however, those reporting acne of some severity were more likely to have seen a physician compared with those who did not report acne (21% vs. 8%, p < 0.001). Blacks who reported mild or moderate severity of acne were more likely to have seen a health professional compared to white respondents with same the acne severity (RR = 3.63, 95% CI = 2.06–6.37 and RR = 3.06, 95% CI = 2.02–4.65, respectively). Conversely, Hispanic respondents with mild or moderate acne were less likely to have seen a health professional compared to whites with the same acne severity (RR = 0.56, 95% CI = 0.35–0.89 and RR = 0.47, 95% CI = 0.26–0.86, respectively). Beliefs about external factors affecting acne also varied by race and ethnicity. In conclusion, the severity, frequency, and beliefs about acne all play a role in help‐seeking behaviors, which vary to a significant extent by race and ethnicity.     

What's new in acne? An analysis of systematic reviews published in 2011–2012

This review summarizes important clinical developments in acne vulgaris identified from 17 systematic reviews published between February 2011 and August 2012. Regarding causes, Demodex mites have been shown to be associated with both acne vulgaris and rosacea, although it is unclear if their eradication improves either disease. Some weak evidence has emerged that suggests a possible link between dairy produce and acne, which warrants further research. With reference to the effects of acne, there is good evidence that acne negatively affects quality of life, self‐esteem and mood in adolescents. Acne is also associated with an increased risk of anxiety, depression and suicidal ideation, highlighting the importance of asking patients with acne directly about psychological issues in order to identify those who might benefit from early psychiatric support. Regarding treatment, there seems to be no additional benefit to using higher strengths of benzoyl peroxide, and lower strengths such as 2.5% have fewer side effects. Despite earlier concerns of increased mortality in those using topical tretinoin for skin cancer prevention, a systematic review on this topic has not found any convincing evidence of a link between such non‐cutaneous events and once‐daily application of 0.02–0.05% tretinoin. Combined oral contraceptives are of benefit in both inflammatory and non‐inflammatory acne. Current surveys suggest that implementation of the pregnancy prevention programme for isotretinoin may not be stringent, and a high level of monitoring and audit is recommended. Ablative and non‐ablative laser resurfacing for the treatment of acne scars may be beneficial, but further studies with a longer follow‐up period are required.